Complete Labial Adhesion in a Post-Pubertal Girl: A Case Report

Labial adhesion usually occurs in the infancy period and in prepubertal girls. It is a rare entity in reproductive age without any hypoestrogenism condition. Voiding dysfunction is a rare manifestation of these conditions. Here, we report a 19-year-old girl with complete labial adhesion presented with urinary retention. A 19-year-old virgin girl was referred to the obstetrics and gynecology department of Ghaem Hospital. She complained of urinary retention. Physical examination was normal except that was moderate hypogastric tenderness and a huge vesical globe. Genital examination revealed complete fusion of the labia minora in the midline, extended from the posterior fourchette to the region of the clitoris covering the entire vaginal introitus, urethral meatus, and clitoris. Despite the use of topical estrogen cream and surgical labial separation, re-adhesion occurred for the third time. Vulvar biopsy confirmed severe inflammation. Finally, topical anti-inflammatory medication improved the symptoms. Although labial adhesion is very rare in the post-pubertal period, it can successfully be managed by medical and surgical treatment.

Management of labial adhesion in a developing country—an observational study

Background Labial adhesion is the fusion of the labia minora or majora. The literature reports conservative management. However, the situation may be different in our setup, where management differs due to prevailing circumstances. The present study was conducted to evaluate labial adhesion presentation, management, and outcome in our center. Methods It was a retrospective observational study from January 2015 to January 2020. The patients were evaluated for age at presentation, presenting symptoms, type of adhesions, treatment, recurrence, and follow-up. The treatment included the manual release of labial adhesion and Mupirocin ointment application for 15 days. They were advised to attend the outpatient department after 1 month for evaluation and later on in case of any problem. Results The total number of patients was 150, of which 104 (69.33%) were from rural backgrounds. The complaint was of the absent vaginal opening in all patients. Seventeen (11.33%) were advised ultrasonography of the abdomen elsewhere to look for the presence of internal genital organs. The local examination revealed poor hygiene in 65 (43.33%) patients. The patient with thick adhesions has minor erythema after the release of adhesions. Ten (6.66%) patients had a recurrence managed by repeat release with no recurrence. Conclusion Despite being a benign entity, labial adhesion may be a cause of severe concern. Manual separation and antibiotic ointment may be a viable first option in its management with minimal recurrence. Maintenance of local hygiene may be needed to prevent a recurrence. The overall outcome is excellent.

An unusual case of labial fusion in a post pubertal girl

Labial fusion is defined as either partial or complete adherence of the labia minora. It is also known as vulvar fusion, labial adhesion, labial agglutination or synechia of the vulva. This condition is common in pre-pubertal girls when estrogen levels are low and commonly resolves spontaneously post-puberty. This condition is usually asymptomatic and can be treated with topical application of estrogen or betamethasone cream or by manual or surgical separation of adhesions. We present a case of labial fusion in post pubertal girl which was managed surgically.

Labial adhesions in a pre-pubertal girl: The importance of awareness

Labial adhesion affects up to 0.6–5% of pre-pubertal girls. They may be congenital or acquired. Patients usually are asymptomatic, and thus, labial adhesions are found incidentally on routine examination. If the patient is indeed truly asymptomatic, there is no need for any treatment, and reassurance only is needed. When treatment is indicated, topical application of oestrogen cream is advised, but when this fails, surgical intervention is recommended. Recurrence is common regardless of the treatment. We present the case of a three-year-old girl managed by release of adhesions under topical anaesthesia and topical application of oestrogen cream.

Post-partum labial adhesion-a case report

A 22 years old primipara presented after 1.5 years of uncomplicated normal vaginal delivery with complaints of difficulty during intercourse and inability to conceive. Examination revealed labial adhesion connecting left and right labia minora with only 5 mm pinhole opening at the posterior end. Surgical division under anaesthesia resulted in successful complete recovery.

Management of young girls with labial adhesion in the clinical and diagnostic Center of N.V. Dmitrieva Regional Children’s Clinical Hospital

Aim. This study aimed to compare the effectiveness of conservative treatment methods, namely, estriol-containing cream and non-hormonal drug, in girls with labial adhesion (LA) in the clinical and diagnostic center of N.V. Dmitrieva Regional Childrens Clinical Hospital. Materials and Methods. A retrospective analysis of pediatric clinical cases of labial adhesion (n=300) was carried out in N.V. Dmitrieva Regional Childrens Clinical Hospital in the period from 2016 to 2018. The study included 150 girls diagnosed with labial adhesion who were treated with estriol-containing cream (study group) and 150 girls with the same diagnosis (control group) who were treated with a non-hormonal gel containing onion extract 10 g, heparin 5000 IU, and allantoin. The age of the participants ranged from 4 months to 2 years and 2 months. Informed consent was obtained from the girls parents for the examination of the child, use of estriol-containing drug or a drug of non-hormonal composition, and processing of personal data. Recovery was considered the absence of recurrent synechiae for 2 years, improvement as not more than one recurrence not earlier than 6 months after the previous treatment, and no effect as two or more recurrences earlier than 6 months. Results. In the main group, recovery, improvement, and no effect were achieved in 108 (72%), 39 (26%), and 3 (2%) girls, respectively. In the control group, recovery, improvement, and no effect was achieved in 30 (20%), 75 (50%), and 45 (30%) girls, respectively. Conclusion. The results revealed the effectiveness and safety of using estriol-containing drugs in young girls diagnosed with labial adhesion.

Postpartum Labial Adhesion Presenting with Apareunia: A Case Report

Labial adhesion is commonly seen in the paediatric and post-menopausal age groups and treatment of this condition with oestrogen cream is effective. On the other hand, postpartum labial adhesion is an unusual complication of vaginal birth except when it associated with trauma to the perineum. In that situation, treatment with oestrogen cream is usually in-effective. A 19-year-old primipara presented 15 months after vaginal birth with difficulty in having sexual intercourse. She had sustained a perineal tear during her last childbirth at home. Pelvic examination revealed fusion of the medial aspect of the labia minora with a membrane inferior to the external urethral opening completely closing the vaginal orifice. A surgical division under anaesthesia was carried out and she resumed sexual intercourse within five days. Postpartum labial adhesion is an uncommon complication of vaginal births and surgical division of labial adhesions is the first line of management. Good postpartum perineal care for perineal laceration following vaginal births should be encouraged to prevent apareunia.